急性糖尿病足患者住院期间低血糖事件可预测截肢的发生  

The predictive role of inpatient hypoglycemia for amputations in patients with acute diabetic foot

作　　者：项家丽(编译) 汤正义(审校)[1] Xiang Jiali;Tang Zhengyi(Shanghai Clinical Center for Endocrine and Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Department of Endocrine and Metabolic Diseases,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病研究所,上海市内分泌代谢病临床医学中心200025

出　　处：《中华内分泌代谢杂志》2019年第12期1073-1078,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：在2019年11月,Journal of Clinical Endocrinology&Metabolism杂志发表了论著《急性糖尿病足患者住院期间血糖测量值与截肢的关系》[Peled S,Pollack R,Elishoov O,et al.Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot.J Clin Endocrinol Metab,2019,104(11):5445-5452.DOI:10.1210/jc.2019-00774],获得原文刊发杂志授权同意后,对该文进行中文编译。本文分析急性糖尿病足患者住院期间血糖情况与截肢的关系。这项回顾性队列研究共纳入了2015年至2017年因急性糖尿病足而住院的糖尿病足患者418例,收集其临床病史、住院期间实验室检查结果和血糖监测值等相关信息。主要观察结局为住院期间任何形式的截肢和大截肢。418例患者住院期间共监测血糖45496次,发生高血糖或低血糖或严重低血糖的患者住院期间行任何形式的截肢或者大截肢的概率更高。高血糖变异性与大截肢的风险增加有关。周围血管疾病、更高的Wagner分级以及低血糖事件是任何形式截肢的独立预测因素。高龄、周围血管疾病、截肢史、白细胞升高、更高的Wagner分级以及低血糖事件是大截肢的独立危险因素。低血糖事件是任何形式的截肢以及大截肢的危险因素。低血糖是否直接导致了不良结局的发生依然不清楚,然而减少住院低血糖事件的发生依然很有必要。In Nov 2019,"The Journal of Clinical Endocrinology&Metabolism"published an article"Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot"[Peled S,Pollack R,Elishoov O,et al.J Clin Endocrinol Metab,2019,104(11):5445-5452.DOI:10.1210/jc.2019-00774],with the permission of the original journal,we translated it into Chinese.This article studied the relationship of glycemic indices during hospitalization with amputations in patients with acute diabetic foot.The retrospective cohort study included 418 patients admitted with acute diabetic foot in the diabetic foot unit during 2015-2017.Information on demographic characteristics,medical history,laboratory tests,and point-of-care glucose measurements were collected.The primary outcomes were any or major amputation during hospitalization.45496 glucose measurements were taken for 418 patients hospitalized with acute diabetic foot.Patients experiencing any hyperglycemia and any or severe hypoglycemia were more likely to undergo any or major amputations during hospitalization.High glycemic variability was associated with major amputations.Peripheral vascular disease,high Wagner score,and hypoglycemia were independent predictors of amputations.Older age,peripheral vascular disease,previous amputation,elevated white blood cell,high Wagner score,and hypoglycemia were independent predictors of major amputations.Hypoglycemia appeared to be an independent risk factor for any and major amputations.While it is unclear whether hypoglycemia directly contributes to adverse outcomes,efforts to minimize in-hospital hypoglycemic events are needed.

关 键 词：高血糖 低血糖 血糖变异性 截肢 糖尿病足 

分 类 号：R587[医药卫生—内分泌]